So, as many of you know, quality and safety are the horizontal threads that run through the tapestry of all we do to provide safe and effective care for our patients. The work to bring this about takes every member of the care team working at the top of their game. So, for the first lecture, we're going to talk about the importance of team-based care. Many of you have heard of the Triple Aim as promulgated by the Institute of Healthcare Improvement in 2008. The strategic thinking about these aims began in the 1980s with Dr. Donald Berwick, who was a quality and safety guru. The Triple Aim has served as the North Star for healthcare organizations to align their healthcare delivery model to serve these aims. Improved patient population health, improved patient experience, and lower healthcare costs to try to improve better outcomes. However, the Triple Aim was missing out on an important piece of the puzzle that affected each aim. It's the team taking care of the patients. By 2014, this piece became widely recognized as critical to achieving these aims. And in 2020, this came to a head when the COVID pandemic hit. Burnout, job dissatisfaction, exhaustion, cynicism, loss of autonomy, and criticism played havoc with healthcare providers, resulting in the Great Retirement in which many technicians, outside healthcare personnel, nurses, and physicians left healthcare altogether. Improved clinician experience was recognized as the fourth aim to achieve. And in 2022, a fifth aim was advocated, that of an imperative to advanced healthcare equity. So realizing that team-based care is critical, growth in team-based models of healthcare have emerged. Many of you have seen this in the hospital setting because of the complexity of care delivered there. Yet models of team-based care have lagged in the outpatient setting. But no matter the setting, the lack of focus on those providing the care will result in the lack of achieving the original triple aims as well as the new triple aims. Thus, building an effective team is imperative. So how do we define a healthcare team? This is actually one common definition. What are the goals of a team-based model of care? And here is one common concept. So here's our first polling question. Who makes up your team? And some of you may answer D because you may include other things. So I find that interesting, right? I think most people do include office personnel and other team members as part of their overall team. You may want to also think about other people who are involved with patient care. There's actually quite a bit of data that have increasingly shown that endoscopy teams that are not only patient-centered but also team-centered have better outcomes and greater staff satisfaction, which is a win-win. Most people, most endoscopy teams include all of these different people, right? And you may have other people on your team as well. I noticed that maybe the people who answered D might have included their biomedical engineers and their IT people, their electronic health record people as part of their team. So teams are important because they're much greater than the sum of the individuals making them up. Better health, better patient care, more innovative ideas, higher productivity, improved efficiency, and fewer medical errors are seen with high-performing teams. So now we'll go on to our next polling question here. What principle is emblematic of a high-performing team? Wow, this is very interesting. I think that this probably shows that really every one of these is probably an appropriate high-performing team or emblematic of a high-performing team. Having your ADR report card, which I don't think anybody answered, is an important way to improve ADR by having a public display of each physician's report card and or the unit's report card because that's something that is important from a quality perspective for colonoscopy. So, if you're going to capture one thing from this talk, I think this is the chart you want to keep and bring to your team. It highlights the principles of high-performing teams, including shared goals, which may even include a mission statement, clear roles, mutual trust or psychological safety, effective communication, and measurable qualitative and quantitative processes and performance outcomes, including assessment of the team structure to determine whether changes are needed and the impact on each team member's well-being. There are six strategies to consider in creating a high-performing team culture. Not all teams are created equal. Every unit has unique circumstances in which teams are formed. There are different challenges and different resources in which each team functions depending on the environment the team is in. So the first strategy is to develop a North Star mission statement. When there are common purposes and goals, team members share a greater sense of camaraderie and are more motivated. It gives team members themselves a sense of purpose and helps break down silos and avoid silos which impair teamwork. In the example of patient care as our priority mission statement, many of you can appreciate the story of a custodian whose main job was to clean the restrooms of the endoscopy unit who sat down with a patient who had difficulty in reading his prep instructions and going over them with pictures so the patient could get it done correctly. The custodian recognized a need and stepped in to assist, yet how many of you would consider the custodian or environmental services worker a part of your team? So success is reaching that North Star purpose and is all about how your team does overall, not on how one physician or nurse does. The second strategy is to develop team agreements. Several teams have established standards of operations that they work under. When developing these agreements, some questions to consider include what are the behaviors we need from each other to establish greater trust and psychological safety? How do team decisions get made? How do we ensure that everyone's voice is heard? One trick I've used is to have everyone submit their opinion individually and then bring together a team meeting to discuss all of these ideas. This process prevents groupthink, which can inhibit someone from providing a great idea in the setting of a team meeting because of potential fear of embarrassment or shame. High-performing teams have clear roles and responsibilities. Understanding them and knowing them, team members can then find opportunities to help each other, including assisting other colleagues. And even when it doesn't fill their job role or responsibility, like our custodian that I mentioned before, high-performing teams also have clear metrics to help measure goals and processes as a way to define success. Success boosts team morale and reinforces team mission and helps teams identify factors that have contributed to their success. When success is not met, everyone on the team can provide solutions and strategies to address problems that arise. Every team should learn from its mistakes and failures. I'm going to pick on a famous Michael Jordan because of ASGE being in Chicago. Everyone knows that he's probably the greatest of all time basketball player. He famously said, I've missed more than 9,000 shots in my career. I've lost almost 300 games, 26 times I've been trusted to take the game-winning shot and missed. I've failed over and over and over again in my life. And that is why I succeed. So failure isn't accepted. It's just expected. When you stretch yourself past your current limits, failure is going to be inevitable. It spawns growth. You can only reach the top and stay at the top by continually improving. And when teams learn together, they bond together. Discovering reasons for mistakes and learning how to address failure rather than blaming, punishing, or embarrassing team members makes teams stronger. This process should be embedded in your team agreement. So this figure shows the classic PDSA method for improving process or carrying out change. Your team culture should embody mutual trust or psychological safety to openly discuss errors and near misses to improve patient care and safety. Sharing knowledge is also a hallmark of strong teams. Learning and developing new processes and skills, including people skills and new endoscopic devices, accessories, and technology improve team effectiveness. Giving everyone on your team opportunities to contribute and learn makes your team stronger. Simulating a particular scenario, such as an angry patient, gathering data from experience, reviewing how these processes occurred, create opportunities for continued learning and improvement. One way a team can improve is if there's specific knowledge or skill that does not exist on the team. One or more of the team members can go out and get that knowledge or skill and bring it to the rest of the team. Sharing knowledge builds relationships and creates a sense of belonging and value. The last thing I would recommend is to provide opportunities for team engagement on a personal level. Team building activities are a key way to develop mutual trust. Such activities can include things like personality workshops, compliment circles, code name games, lunch and learn workshops. So for example, someone who's really good at Excel shows everyone else on the team how to use Excel effectively. Or someone who speaks Spanish fluently teaches other people on the team common phrases to use or a healthy cooking class is held. Engaging your team in a special hospital-wide project or a volunteer community service project are other ways to build team culture. And finally, celebrate your team successes. Celebrate both the team accomplishments and personal accomplishments and think about nominating your team members for hospital or unit-based awards. You really need to carve out the time and the schedule for your team to plan and strategize. Hold think tank sessions at outside venues that incorporate everyone's input. So team stands for together, everyone achieves more. Thank you for listening. We hope this presentation has given you ideas to make your team stronger and more effective.

team-based care

patient outcomes

healthcare goals

high-performing teams

team culture